Day 2 :
Cooper Medical School of Rowan University | USA
Keynote: Progesterone receptor modulation provide a safe convenient method for palliation of advanced cancers of all types
Time : 9:30-10:15
Jerome H Check is a Professor of Obstetrics and Gynecology at Cooper Medical School of Rowan University and is the Division Head of Reproductive Endocrinology & Infertility at Cooper Hospital, Camden, NJ. He is also board certified in internal medicine and medical endocrinology. His Ph.D. is in reproductive biology. He has published over 750 peer-reviewed scientific articles that include reproductive and medical endocrinology, immunology, molecular biology, internal medicine, and cancer research. His work involving palliative care includes novel treatments for pain, chronic disease, and prevention of metastases of cancer.
Statement of problem: The progesterone induced blocking factor (PIBF) is a unique intracytoplasmic protein present only in rapidly proliferating cells. PIBF helps both the fetal/placental unit and malignant tumors escape immune surveillance by natural killer (NK) cells and cytotoxic T-lymphocytes. Progesterone up-regulates and mifepristone (a progesterone receptor modulator) down-regulates PIBF. Because mifepristone is an abortafacient, most governmental agencies have restricted its off-label use. Compassionate use IND’s granted by the FDA has allowed mifepristone treatment on an individual case basis for a variety of advanced cancers not responding to conventional therapy, and significant palliation has been provided to patients with a variety of different cancers based on improved longevity and quality of life.
Methodology and theoretical orientation: The FDA granted an IND to evaluate single agent oral mifepristone 300mg for stage IIIB or IV non-small cell lung cancer that has progressed despite a minimum of at least 2 chemotherapy or immunotherapy regimens. The response of the first two cases treated is listed below.
Findings: A male and female, both age 68 failed multiple standard chemotherapy regimens for their stage IV lung cancer. The female progressed despite also receiving immunotherapy with nivolumab (PD-L1 marker present). The male (who had seizures related to brain metastases) has had no more seizures with brain lesions gone and 75% shrinkage of lung lesions. He is ECOG zero and states he feels so good it is hard to believe he has cancer after 16 months of mifepristone. The female has shown more energy and no further metastases after 6 months of therapy (ECOG-1 related to COPD).
Conclusions: Palliative care specialists should unite and petition governmental agencies to lift the ban for off-label use of mifepristone at least to patients with advanced cancer. Mifepristone is very well tolerated and has fewer side effects than anti-PD-L1 drugs.
Philadelphia University| USA
Time : 10:15-11:00
Kennedy is currently an assistant professor in the Community and Trauma Counseling Program at Philadelphia University. She has served in many capacities as an administrator, clinical therapist and supervisor, and hospice chaplain. She has served as Director of the Life Center at Hospice of the Chesapeake, which provides support services and programs for hospice patients and families, and bereavement and trauma counseling to adults, teens and children. Dr. Kennedy began her career as a case manager in the HIV/AIDS epidemic. She holds a Bachelor’s and a Master’s degree from the University of Iowa, a Master of Divinity from Harvard University, and a Ph.D. from Loyola University Maryland. She is a Licensed Professional Counselor (LPC) in Pennsylvania, and an ordained minister in the United Church of Christ denomination. Her specialty areas include grief and bereavement, life-limiting illness, trauma, spiritual alienation, gender identity, sexual orientation, and support to the LGBTQ+ community.
Research indicates complex trauma is an increasing public health concern and involves threats to personal safety; selfidentity and connection to the wider community. Despite not meeting the full criteria for PTSD, this category of trauma appears to be the most debilitating and results in secondary complications that include interpersonal violence, drug use, depression, and anxiety (Courtois & Ford, 2013; Park, Currier, Harris, & Slattery, 2017). Further, some argue the DSM-5’s definition of trauma is too narrow and does not account for other debilitating events such as major losses, including life-limiting
illness and grief that result in clinically significant symptoms (Briere, 2013). The impact of trauma on our living and our dying
is undeniable. Losing a loved one to death is one of the most painful experiences of being human. Grief, considered the normal response to bereavement, is associated with potential long-term physical and psychological sequelae such as increased mortality, cardiac disease, depression, and substance use. Complicated grief has been linked to brain abnormalities that impact functioning of the limbic system, autobiographical memory, and cognitive processing (Shear, 2015). Given these findings, therapies that focus on cognitive restructuring may be ineffective in reducing distress. Eye Movement Desensitization and Reprocessing (EMDR), has been used extensively to treat individuals with PTSD (Van der Kolk, 2015). Emerging research suggests that EMDR is an effective intervention for complex trauma, grief, chronic pain, and substance use disorders (Abel & O’Brien, 2013). The focus of the workshop is to present research on the intersectionality of trauma and grief and their impact
on brain development and function; introduce EMDR and discuss implications for use with hospice patients, families and the bereaved. An experiential segment will guide participants through EMDR exercises followed by small group discussion.
- Palliative Care | Geriatrics | Spiritual Care | End of Life Care | Chronic Diseases | Symptom Management | Oncology
Location: Doubletree by Hilton
Jerome H Check
Cooper Medical School of Rowan University | USA
King Fahad Specialist Hospital| Saudi Arabia
Background: The identification of the magnitude and pattern of cancer is the first step in determining clues to the cause(s) of cancer and in having a baseline to plan and assess control measures.
Aim of Study: The aim of this study is to explore magnitude, pattern and some epidemiological aspects in relation to cancer in palliative cases at a tertiary care level hospital.
Methodology: This study has been conducted at King Fahad Specialist Hospital (KFSH) in Dammam City. Data collection was based on the hospital’s electronic records for palliative patients admitted during 2014, 2015 and the first half of 2016.
Results: Cancer colon, cancer breast lung cancer, cancer pancreas, cancer stomach, leukemia and gall bladder cancer occupy the highest proportions among patients admitted to the KFSH. The proportion of patients with cancer colon showed a slight decline from 2014 to 2016 (17.3%, 10.4% and 11.5%, respectively), while that for breast cancer showed a slight increase (15.9%, 15.7% and 18.4%, respectively). The incidence of medication toxicity among palliative patients admitted to KFSH decreased from 12.9% in 2014 to 5.3% in 2015. Most cancer patients admitted to KFSH during 2014 till 2016 could be maintained at no pain levels during their treatment period. However, some patients had exhausting pain, with decreasing proportions from 2014 till 2016 (6.7%, 5.1% and 4.3%, respectively). About one fourth of patients died (24.3%, 26.3% and 26%, respectively).
Conclusions: The highest proportions of cancer patients attending the KFSH are related to colon, breast, lung, pancreas, stomach, leukaemia and gall bladder. Control of pain and treatment toxicity is quite successful, while in all-palliative cases fatality is quite high.
Recommendations: Exploring the magnitude, pattern and other epidemiological aspects in relation to cancer cases for palliative patient at KFSH should be extended for the coming years and to investigate the reasons that would explain the high proportions of certain types of cancer among attending patients.
Brittney Katsoff, M.D., completed her university training at University of Pennsylvania receive an AB degree (major psychology). She received an M.D. degree from Robert Wood Johnson Medical School. She completed her residency in internal medicine at Temple University School of Medicine and is board certified in internal medicine. She completed her fellowship in Hospice and Palliative Medicine at Drexel University Medical School and is board certified in that specialty. She is the lead or co-author of 45 peer reviewed manuscripts. She is currently working as a specialist in hospice and palliative medicine for Vitas.
Statement of problem: Dextroamphetamine sulfate has many years provided marked relief of pain from a variety of disorders that failed to respond to conventional therapy including, but not limited to, headaches, pelvic pain, interstitial cystitis, fibromyalgia, abdominal pain associated with motility disorders, or inflammatory bowel disease, and rheumatoid arthritis. The present study evaluated the benefits vs. side effects in an 88 year old man suffering from such severe post-herpetic neuralgia over a 5-year duration that he was investigating whether there are any doctors or clinics available where assisted suicide is performed. The patient had failed to improve following treatment with gabapentin, pregabalin, and duloxetine and had marginal relief from lidocaine patches, hydrocodine, oxycodone (all caused nausea), acupuncture and TENS unit.
Findings: The patient was started on dextroamphetamine sulfate 15mg extended release capsule daily starting at age 88 (after 5 years of no relief from left sided flank pain extending to the back same area as herpes infection). His dosage was increased to 30mg which provided 90% relief of pain within 2 months of treatment. The relief lasted 5 years with daily treatment. He died peacefully while sleeping at age 93 pain free for 5 years.
Conclusions: This very elderly man had no side effects from treatment with dextroamphetamine sulfate. The drug is believed to provide amelioration of pain by stimulating the release of dopamine from sympathetic nerve fibers. This biogenic amine function to inhibit cellular permeability. Excess absorption of irritants into the tissues may lead to excessive inflammation leading to pain. Palliative care specialists should be aware of the benefits of sympathomimetic amine therapy for pain even for people in their late 80’s or 90’s.
Statement of problem: Dextroamphetamine sulfate is an approved drug for chronic fatigue associated with cancer and multiple sclerosis. The question that the present study was designed to answer is whether the sympathomimetic amine therapy only helps chronic fatigue associated with cancer, and multiple sclerosis, or could it be used in patients in apparent good health but plagued by severe unexplained chronic fatigue.
Methods: Dextroamphetamine sulfate extended release capsules were administered to 50 patients with unexplained chronic fatigue (thyroid, adrenal, infectious and autoimmune etiologies excluded). The dosage could be increased on a monthly basis to a maximum of 60mg/day. Six months following the final dosage the patients answered a questionnaire: fatigue – 1) worse, 2) stable but no better, 3) slightly better, 4) moderately better, 5) markedly better.
Results: Forty-eight of 50 patients (96%) stated markedly better and 2 patients moderately better.
Conclusions: Dextroamphetamine sulfate not only improves the chronic fatigue for patients with cancer and multiple sclerosis, but also very effective relieves chronic fatigue in otherwise physically normal patients. Thus, this study will hopefully encourage palliative care specialists to consider this treatment for chronic fatigue for other debilitating conditions besides cancer and multiple sclerosis. Furthermore, through approved for chronic fatigue for cancer patients, the drug is likely underutilized by palliative care specialists for patients with cancer. Hopefully this study will generate more interest in treating patients with cancer with dextroamphetamine sulfate. The mechanism is likely related to stimulating the release of dopamine from sympathetic nerve fibers. Dopamine decreases cellular permeability and it has been hypothesized that chemicals permeating into mitochondria may cause dysfunction of the mitochondria in muscles leading to fatigue.